HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: `T
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BY
St. Lucie County �U�
NZs Building Permit Application es � 1
Planning•and Development Services r <0 90e P
Building 2300Vii ginia Avenue, Fort PierceFLa
FL 34982 P 110� 017e,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE:
PROPQSEDJMPROVEMENT LOCATION::.
Address: 5012 Birch Dr. Ft Pierce, FL 34982
Property Tax ID #: Lot No.6 & 7
Site Plan Name: Block No. 45
Project Name: Michael Baumgardner
DETAILED DESCRIPTION OW WORK:
4
V I J
CONSTRUCTION` INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters �rWindows/Doors
✓lectric Plumbing _Sprinklers _Generator ✓Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$_�RS o5lp Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C't cho.4A�y'�bmucn s _cr r
Name:
Address: 50\ ay,�ccA �
Company: C,Z=NC`TDK
Address: 3goo Fi,5faL-O0uk
(
Surriiio�00
City:'� Qi,ce. ecState:FL
Zip Code: 3 '12�9 Fax:
Phone No.? r .-- r ii a- LliJ6- 73>n i
City: W8
Zip Code: -13W 1`1
Phone No lQI
Fax:
-S95
State:
E-Maih'.o.�.owm c:kk,COM
Vo�c�na
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ilo Q
EGEn7C
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State or County icense (260- /-�W03
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It value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
City:
Zip:,
FEE SIMPLE_ TITLE HOLDER_: _ Not Applicable
Name: Al 1F
Address
City:
Zip: Phone:
MORTGAGE COMIyIPANY: _ Not Applicable
Name: Al/At
Address:
City: State:
Zip: Phone:
BONDING CNIRANY: _Not Applicable
Name: rV
Address:
City:
Zip: Phone:
uwNER/ GUNTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and installation as Indicated.
1 certify that no work or Installation has commenced prior to the issuance of a permit
St Lude Counttyy makes no represe t tion that is granting a permit will authorize the ermlt holder to build the subjects tructure
which Is In conflict with any applica��e Home Owners Association rules, bylaws or angcovenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, In all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurfency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SiTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAINS�� Np GIIxY, CEONSULT
WIiH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing Instrument was acknowledged before me
this —day of. 2o_ by
STATE OF FkOR���7
COUNTY OF
The forgoing instrulpent was acknowledge before me
thisndayof J�`^� 20��by
s fA W S-i� ji..
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification �L
Type of Identification Type of Identification
Produced Produced 5 ---JC -
(Signature of Notary Public- State of Florida) (Signature of Notary Plq Ilc- State of FWMFY uOurnY
My Commission Expires Jan 27, 2020
Commission No. (Seal) Commission No. Acting In the CoVoWl
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